1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
In the field of NAFLD, disparities research is in the first generation- identifying, detecting, and documenting disparities. There have been some research on racial/ethnic disparities in NAFLD. The racial/ethnic disparities that have been described have aggregated groups, including Hispanic and Asian. I am interested in disaggregating this data as we know there is heterogeneity within these groups. However, as we have learned in this class, there are more to disparities than racial/ethnic disparities. I am interested in identifying and documenting disparities in NAFLD in addition to racial/ethnic disparities, including based on gender, education, income, language preference, health literacy, insurance status, medical comorbidities. After identifying these disparities, we can work to determine the causal relationships that help us better understand why these health disparities exist for patients with NAFLD. Understanding the causal pathways that underlie these disparities can help inform future interventions to address these disparities.
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
I think engaging the community in addressing health disparities, and literally meeting patients where they are at (something we talk a lot about in medicine), is innovative and increases the likelihood of success in reaching traditionally hard-to-reach patients. Interventions such as the barbershop hypertension intervention, of course need to include key community stakeholders in the development and implementation process. There needs to be buy-in from the community for interventions such as these to work. Some of the projects I have been involved with in the past have been using lay health workers to address smoking cessation among Chinese and Korean Americans. This intervention used lay health workers to provide education on the dangers of smoking as well as the evidence behind nicotine replacement therapy. Engaging lay health workers helped to address issues with language (since we recruited lay health workers who spoke the participants’ language), but also helped to address some of the other cultural issues such as stigma and other cultural beliefs around smoking that may not have been able to be addressed without having community members involved. One of the big issues in one of research projects is screening for chronic hepatitis B. The rates are notoriously low in some populations, particularly African Americans and certain Asian ethnicities. Engaging lay health workers may help to clarify some of the reasons behind why screening rates are so low and develop interventions that might help address these disparities.